MODEL FORMS OF COMPLAINT

UNDER THE CONSUMER PROTECTION ACT, 1986

Before the Hon'ble District Consumer Disputes Redressal Forum at- Nainital
OR
Before the Hon'ble State Consumer Disputes Redressal Commission at- Uttarakhand
1. Particulars of complainant:
a. Full Name: Bhavana Tewari
b. Complete Address: Bora Niwas Nawabi Road Haldwani, Uttarakhand.
c. Village, Tehsil, City and State: Haldwani, Uttarakhand.
2. Particulars of the Opposite party:

Opposite party No. 1

a. Full Name of dealer/shop/Firm/manufacture: Sachdeva Store.
b. Complete Address: Thandi Sadak, Kathgodam, Haldwani, Uttarakhand.
c. Village, Tehsil, City and State: Haldwani, Uttarakhand.

3. Particulars relating to goods/services complained of:

a. Details of goods/service:
a. Item of goods with quantum/nature of service:
b. Date when goods purchased/service obtained:
c. Amount paid as consideration:
(Attach photocopies of bill/voucher/receipt etc.)
(b) Whether the complaint relates to:
a. Loss or damage as a result of unfair trade practice adopted by the trader:
b. One or more defects in goods:
c. Deficiency in services:
d. Excess price charged by trader (above the price fixed by or under any law for the
time being in force of displayed on goods or package containing such goods):
(c) If the complaint relates to (b)(1) above.
Please indicate the nature of unfair trade practice adopted by the trader, such as
- Statement as to the quality etc. of foods sold/service made:
- Sponsorship of goods/dealers:
- Warranty/guarantee with period promised
(attach photocopy of warranty/guarantee card, if any):
- Disparaging of goods of other traders:
(d) If the complaint relates to (b)(ii), nature and extent of defects in goods:
(e) If the complaint relates to (b)(ii), nature and extend of deficiencies in service:
(f) If the complaint relates to (b)(iv), details of price fixed and price charged:
(g) Any other details connect with the complaint (Such as, when defect in goods or deficiency
in service was first noticed):
4. Details of attempts made to get the matter complained of settled and result thereof:
a. Personal negotiations:
b. Written communication with trader/opposite party: (attach copies of correspondence)
c. Application made to other authorities such as M.R.T.P. Commission.
5. Whether any other law/rules/regulations/procedure applicable:
6. Details of documents/witnesses relied upon to substantiate the complaint.
7. Relief claimed:
a. To get defects in the goods removed and/or
b. To replace the goods with new goods and/or
c. To return the price/charges paid
(iv) Compensation claimed for financial loss/injury/interest suffered due to the negligence of
the opposite party/parties. (Justify with reasons the extent of compensation claimed for the
loss or injury)
8. the Forum/State Commission has jurisdiction to entertain the complaint in view of-
a. Section 11(i)/Sec 17 of the Consumer Protection Act
b. The extent of amount involved being Rs:
c. The cause of action having accrued at:
 PRAYER
It is, therefore most respectfully prayed that (here give details of prayer)
---------------------------
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---- Through -------------------------------------------------- Authorized.
Representative/Advocate/Voluntary Consumer Association (give here names and addresses)
Place --------------
Date --------------
COMPLAINANT
 VERIFICATION
I, -------------------------------------- S/o ------------------------------------ resident of
------------------- ----------------------------- do solemnly declare and state that the particulars
stated above are true to the best of my knowledge and belief and no part thereof is false and
nothing material has been concealed therefrom. The annexures are exact copies/translation of
their originals. I undertake to pay any sum required for the conducting of test in the
laboratory as per the provisions of Sec. 13(1)(d) of the Consumer Protection Act, 1986.
Verified at --------------- this ------------ day of -------------- two thousand and ------------------

DEPONENT.

Enclosure (Mark enclosures as Annexure I, II, III etc.)

1. ---------------------------------------------------
2. ---------------------------------------------------
3. ---------------------------------------------------
 MODEL FORM OF APPEAL
Before the Hon'ble Consumer Disputes Redressal Commission (State Commission)
At --------------------------------------
(Appellate Jurisdiction)
Memorandum of Appeal No. --------------------------------- of --------------------
IN THE MATTER OF
Name : -----------------------------------------------------------------------------------
Full Address: ---------------------------------------------------------------------------
Village/Tehsil/District: ---------------------------------------------------------------
Versus
Name : -----------------------------------------------------------------------------------
FullAddress---------------------------------------------------------------------------
Village/Tehsil/District: ---------------------------------------------------------------

The humble appeal of Appellant(s) above named most respectfully showed:

1. This appeal is directed under Section 15 of the Consumer Protection Act, 1986 against the
order of the District forum ----------------------------- In application No. ---------------------- of
------------- ---------------------- passed on --------------------------- received by the appellant on
-------------------------
2. This appeal is filed within the time limit provided under Section 15 of the Consumer
Protection Act, 1986/ This appeal being, barred by limitation, is accompanied by an
application for condonation of delay for consideration by the Commission, as per rules
----------------------- of the Consumer Protection Rules of --------------------------------------
State (delete whichever is not applicable).
3. Brief facts of the case are stated hereunder (Please furnish herein the details of the case and
the decision of the District Forum):
--------------------------------------------------------------------------------------------
4. The grounds on which appeal is preferred are stated here under (the grounds should be
numbered consecutively without any arguments of narrative):
5. The appellant has not preferred any other appeal against the order impugned herein.
6. PRAYER: It is, therefore, respectfully prayed that your Lordship may be graciously
pleased to allow the appeal and set aside/modify the order of the District Forum appealed
against.
7. List of enclosures:
1. Certified copy of the order of the District Forum appealed against.
2. Affidavit.
3. --------------------------------------------
4. --------------------------------------------
PLACE: ------------------
DATE: ------------------ SIGNATURE
(To be signed by the Appellant and Authorized Representative/Associate